1. Running head: COMMUNICATION IN NURSING LEADERSHIP
Communication in Nursing Leadership
Ricci M. Hayes
ORG300 – Applying Leadership Principles
Colorado State University – Global Campus
Sheila Landfair Mueller, Ph.D.
March 19, 2015

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Communication in Nursing Leadership
The quality of communication in nursing drives patient outcomes, both positively (health
maintenance and/or restoration), and negatively (increased mortality rates, and/or company
bottom line). Our leadership is cemented by our ability to clearly communicate, and to do so we
are well informed, we engage teams in pursuance of optimum care, and are malleable in our
approach with patients to best suit their individual needs.
Keeping Current
It should be comforting to read that nurses utilize evidence based practice, and ideally,
they would. But the authors of “Nurses’ Information Use and Literature Searching Skills…”
(Majid, Foo, Zhang, Mokhtar, Luy, Chang, & Theng, 2013) have identified a lag time between
published research and practice, as long as 17 years (p.69, para.2). When I consider that this
means I may be practicing using information from 1998, I’m alarmed.
Evidence vs. Policy
Company policy usually directs my own practice, however, I did question policy for
preparing central venous catheters (CVCs), when it called for an initial cleaning of the catheter
hub with alcohol, while ignoring the need to clean the hub between syringe changes (Lockman,
Heitmiller, Ascenzi, & Berkowitz, 2011). Evidence was contradictory to policy. Although I have
been unable to sway the policy writers of my company, I am confident that when I clean CVCs,
my practice doesn’t put patients at risk. Honestly, I rarely question what I do and don’t do in the
course of any given day, and even if I did, where would I find reliable publications to answer my
concerns or questions?

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Searching for Answers
Analysts (Majid, Foo, Zhang, Mokhtar, Luy, Chang, & Theng, 2013) polled 2100 nurses
about information sources to address three main questions:
a) What medical information sources do nurses use to meet their professional needs?
b) What search features do nurses use when searching online health care information
sources?
c) How familiar are nurses with the use of different search operators? (p.70, para.1).
By their study of the 1,486 respondents, they determined that human and print sources were most
frequently relied upon, and speculated that this was “…probably due to their higher accessibility
and the convenience…” (p.76, para.1), and that underutilization of internet resources might be
because “…only a very small percentage of nurses picked up an appropriate search statement for
a given hypothetical topic” (p.76, para.2). Having returned to school, I recognize that peers have
often better utilized search engines than I; their works cited are more current. But all is not lost.
The authors confirmed previous studies “…which suggested that training and education could
improve practitioners’ information seeking skills” (p.76, para.3). If evidence based practice is
our motto, we need to educate ourselves on where and how to find the evidence, as well as
ensure those whom we mentor and coach can adequately demonstrate such skills.
Engaging Teams
In precepting new nurses, I generally take a “focus on the positive” approach. For
example, “This wasn’t done correctly,” can evoke feelings of defensiveness and close
communication, whereas, “Show me how you arrived at this step,” allows both the teacher and
learner to evaluate the learning process. But this isn’t always the case. In “The Two Faces of
High-Self Monitors…” (Oh, Charlier, Mount, & Berry, 2014), authors studied counterproductive

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work behaviors (CWBs) within organizations and towards individuals and determined that
CWBs are:
…prevalent…and expensive to organizations…have negative consequences (e.g.
low overall performance, personal ailment)…[and] account for as much as 20
percent of failed businesses…(p.93, para.3).
CWBs are dysfunctional behaviors, such as rudeness, rule breaking, or any actions
contrary to the company’s health (p.92, para.2). Many days I feel pushed to the point of
being angry, and admit that I have misdirected my frustration at my team and/or my
employer. How can I inspire if I demonstrate a reckless disregard for individuals and/or
my company? Would I trust me?
Breeding Professionalism
Leaders need the trust of followers in order to be effective, and it seems a given
that those affiliated with CWBs lose trust. How better can I perform in my leadership
role? In their book titled, “New Leadership for Today’s Health Care Professionals…”
(Rubio, Salvador & Chassiakos, 2014), authors highlight three key components to
professionalism: Character, conduct, and quality. They state that such professionalism
“…results in better patient care and improved organizational outcomes” (ch.4, sec.2).
Addressing the Audience
Just as nurses lead teams, we motivate our patients to participate in their care
plans: They are the center of the team and some of the most crucial communication
occurs between them and their nurses. Health literacy (HL), as defined by Lie (2011), is a
“…skill set that concerns the ability to perform basic reading and numerical tasks for
functioning in the healthcare environment and acting on healthcare information” (p.2,

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para.1). Low HL is correlated with increased morbidity, lower use of preventative and
screening measures, increased error in medication use, and an overall cost “… estimated
at over $73 billion annually” (p.2, para.2). Lie points out that most health information is
written at twelfth grade level, while average HL is at eighth grade level (p.2, para.8) and
that practitioners consistently overestimate their patients’ abilities to grasp healthcare
information and resources available.
Bridging the gap
What can we do about the disparity between the message sent and the message
received? In nursing school, I learned that the best way to assess a patient’s
understanding is by return demonstration; in other words, learn one – do one – teach one.
It was not a stretch therefore, to read that experts versed in HL agree that “teach-back
technique” (p.2, para.12) is the most effective. Despite this general understanding by
nurses and providers, we consistently use “…less effective techniques such as simple
language (99%) or repeating key information (92%)” (p.2, para.12). As nurses, we are
called to adequately assess our patients’ needs. Communication needs are addressed to
their benefit, and ignored to their detriment.
Conclusion
As leaders, nurses directly affect patient outcomes both positively and negatively.
We have the responsibility to be well informed, engaging to our team, and adaptable to
our patients’ needs if we are to promote and restore health for individuals, as well as
discard behaviors that are not only detrimental to organizational solvency, but lead to
increased mortality for patients.

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References
Lockman, J. L., Heitmiller, E. S., Ascenzi, J. A., & Berkowitz, I. (2011). Scrub the hub! Catheter
needleless port decontamination. American Society of Anesthesiology, 114(4), 958.
Majid, S., Foo, S., Zhang, X., Mokhtar, I. A., Luy, B., Chang, Y. K., & Theng, Y. L. (2013).
Nurses’ information use and literature searching skills for evidence based practices.
Malaysian Journal of Library & Information Science, 18(1), 667-778.
Oh, I. S., Charlier, S. D., Mount, M. K., & Berry, C. M. (2014, January). The two faces of high
self-monitors: Chameleonic moderating effects of self-monitoring on the relationships
between personality traits and counterproductive work behaviors. Journal of
Organizational Behavior, 35(1), 92-111. doi: 10.1002/job.1856
Lie, D. (2012, March 29). Limited health literacy: The impact on adherence. Medscape Family
Medicine, Cases in Health Disparity. Retrieved from
http://www.medscape.com/viewarticle/739582
Rubino, L. G., Salvador, J. E., & Chassiakos, Y. S. (2014). New leadership for today’s health
care professionals: Concepts and cases [Books24x7 Version]. Retrieved from
CSUGlobal.edu

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Appendix A
Peer Review Journal Search
The first journal used, “Nurses’ Information Use…” startled me, mostly from the assertion that
research publications took a road of roughly 17 years to become part of evidence based practices.
The challenges expressed by nurses in searching for reliable online searches resonated with me,
and thereby narrowed my paper topic. The other journal I used, “The Two Faces of High-Self
Monitors…” drew me in by its indication that counterproductive work behaviors caused
businesses to go under. I see these behaviors in myself and others, and if they apply to the
general business model, I could narrowly apply them to the healthcare model.
Process
I have used the CSU library for previous two discussions in ORG300. Process began and was
adapted as follows:
1. Key word(s) “leadership and communication” which yielded 42,045 results.
2. Limits applied were: “references available”, “scholarly”, “academic journals”, “journals”,
which reduced the yield to 522.
3. In the AND tab I entered “education” which yielded 30 results.
Using the right search words and parameters proves challenging. I plan to better master this skill
before leaving ORG300.
In order to ensure that the journals used were academic rather than journalistic, I noted that the
articles were not laden with color print photos, were written by field experts, and contained
multiple reliable references. Furthermore, the articles were not slanted one way or the other, but
rather presented the information and drew reasonable conclusions, or else suggested questions
that would lead to further research.

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Appendix B
Internet Search
The web based article used for this paper, “Limited Health Literacy…” was from Medscape, a
reliable source of new healthcare journals and research which I have used previously. Using the
CRAP test, I evaluated the legitimacy of the article.
Current: Article was published in 2011.
Anything prior to 2010, I scrolled by.
Relevant: Adherence to treatment plan is a
familiar challenge for me. Honestly, though
‘health literacy’ is a phrase that generated
many hits, I didn’t realize it was so vastly
studied. Communication is key, and the section
noting the prevalence of simple language
utilized by healthcare providers despite
contradictory research got my attention. The
assertions made in the article were supported
by multiple researchers.
Authority: It was written by an MD, case
studies were provided, and relevant financial
relationship disclosure was provided for
evaluation.
Purpose/Point of view: To highlight a
particular barrier to adherence and to illustrate
daily assumptions that lead to poor patient
outcomes.
To consider the reliability of any given website, one should give greater credibility to urls ending
in “edu” or “org”. Mine is Medscape.com, the “com” not generally favored; however, because I
had used this website extensively in previous healthcare research, I was confident in using
articles found. To ensure I was not using an opinion piece, I put it to the CRAP test above. A
website offers a variety of information, both current and historical.

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Appendix C
eBook Search
The audience targeted in “New Leadership…” is healthcare students, a topic relevant to my own
degree pursuance (B.S. Healthcare Administration and Management). Because I had already
accumulated articles about the barriers to effective communication, I welcomed this book as a
source for successful leadership principles.
A book provides greater detail and length than reasonable articles are able, and expand
information within a narrow subject.

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Appendix D
Critical Thinking
In the previous three appendices I demonstrated how I tested source credibility and
relevance to my topic. Perhaps what is missing are all of the articles and books that I didn’t use.
For example, several web based articles seemed promising, but after reading them, I determined
that they were more opinion pieces. When I searched for an eBook (a new skill) I was frustrated
and discarded any for which I could not immediately find the reference page. For one book, I
was reading along the key quotations and thought, “Yes, perfect”. Though the book was timely
in my opinion – from 2010 – the references were from the 80s and 90s; I could overlook one or
two citations that were 20, or 30 years old if they provided a historical comparison. But most of
the references were aged, and therefore, did not meet criteria.
Module 2 addressed the importance of evaluating resources, as well as challenging one’s
own assumptions. How did I reach my conclusion? Did I assume or analyze? Communication in
nursing leadership is obviously, a broad title, impossible to flesh out in four pages. Though I was
able to hone in on some specific barriers and tools, it was mostly through reading the articles
themselves rather than having a specific goal in mind. My sail was dictated by the wind, so to
speak. Ideally, I will captain and navigate the course.
The video “How to Think Critically” was brief but meaningful, especially in that the
creator demonstrated that answering the Who-What-Where-When, leads you naturally to the
How-Why questions, where the critical thinking really begins. Considering patients’ adherence
or lack thereof, I’m driven to the why. I’m sure my work did not illuminate the complexities of
human behavior, but my research did make me curious to know more about health literacy. As
they say, the more you know, the more you don’t…and if I am open, the more I will.